Starting Thursday, the 155,000 people enrolled in the Washington Health Benefit Exchange must pay their insurers directly, a change aimed at simplifying a payment system previous plagued with problems.
There have been weeks, even months, of warnings and notices, but starting Thursday, the 155,000 people enrolled in the Washington Health Benefit Exchange (WHBE) must pay their insurance companies directly instead of sending premiums to the state-run program.
“After Wednesday at 5 p.m., we’ll no longer be aggregating premiums or accepting payments,” said Michael Marchand, spokesman for WHBE, which operates the state’s health insurance marketplace under the Affordable Care Act (ACA).
WHBE officials voted last December to stop managing customer invoices and payments, partly to simplify the process — eliminating a middleman — and partly to halt glitches that left hundreds of enrollees with missed payments, lapsed insurance and incorrect bills.
“I think the anticipation is that this is going to help dramatically reduce the number of problems that consumers have with the exchange,” said Mike Kreidler, the state insurance commissioner.
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The change will benefit consumers directly, while also improving coordination between the exchange and insurers, said Pam MacEwan, WHBE chief executive.
“This frees the Exchange to do what we do best, providing easy comparison of health plans, access to financial assistance and help with enrollment,” she said in a statement.
Washington was one of just four states — including Massachusetts, Rhode Island and Vermont — that originally agreed to use so-called premium aggregation, in which the exchange collected individual payments, then forwarded the combined funds to carriers. Having insurers handle payments is actually the norm, officials noted.
Still, both insurers and exchange officials acknowledged they’re anxious about a move that shifts the $560 million in premium payments WHBE handled last year to 16 separate insurers.
“This was quite an undertaking,” said Marchand, who noted that WHBE has been sending notices to consumers since May. “It’s been going on for a while, but, as you can imagine, there are individuals who haven’t heeded the change.”
WHBE officials earlier reported enrollment of 164,000, but revised it to 155,000, lower than its projected 213,000 goal for 2015.
Only about a quarter of enrollees were sending payments directly to insurers as of late August, Marchand said. That leaves three-quarters who must make the switch this week.
At Premera Blue Cross of Washington, which has enrolled about 73,000 of the state’s WHBE clients through two programs, only about 21 percent are now paying the insurer directly, said Melanie Coon, a spokeswoman.
Consumers can pay their October premiums through the exchange until 4:59 p.m. on Wednesday, but after that, they’ll need to submit payments to their individual carriers. Instructions for payment are available on the Washington Healthplanfinder website.
The change requires effort for clients who use credit or debit cards or automatic bank withdrawals to make payments, Marchand and Coon cautioned. Premera won’t accept automatic payments until the December premium, noted Coon.
Exchange officials and insurers said they anticipate that there will be problems with the switch.
“We’re expecting a small number of existing customer accounts and invoices might require additional attention,” Marchand said. Coon said that there might be thousands of customers who experience problems, largely because of technical issues related to the change.
But WHBE and the insurance companies have been working for months to set up joint-response teams aimed at solving clients’ problems in real time, they said.
That’s key, said Kreidler, who said he’s concerned that some consumers will get “caught between a rock and a hard place” in the change.
“If it’s a disagreement between the exchange and the insurer, it will be one where the consumer will be held harmless,” he said. “They’re going to keep their insurance and if they have a surgery, it’ll take place as scheduled. If they have cancer treatment, they’ll get their treatment.”
The exchange website will be offline starting at 5 p.m. Wednesday for technical updates, Marchand said.
The payment change does not apply to small businesses, which are required to use premium aggregation under terms of the health-care law, Marchand said.
The next open-enrollment period begins on Nov. 1, for health-insurance coverage starting Jan. 1, 2016. Open enrollment continues through Jan. 31, 2016.
Months of work have gone into the individual- and family-market switch, but it will probably take until October, when the insurers generate their first invoices, to gauge success, officials said.
“There’s a lot of anxiety out there right now, whether it’s with the exchange or the health insurers, because everyone wants to make sure it runs as smoothly as it needs to,” Kreidler said.